Preventive Care is a Sick Idea

When it comes to unhealthy behavior, some of us can't be helped.

Despite the extraordinary energy exerted in trying to delay the inevitable, the inconvenient fact is we all die.

So it is no surprise that "preventive" health care, that game-changing fix to policy trotted out relentlessly by both Democrats and Republicans, is so appealing. And like many cure-alls, it's a myth.

Surely, for some, preventive health care is worthwhile. And no one is stopping you from eating an apple. But unless policy changes have the power to stop the Grim Reaper—rather than only postpone his arrival—it will make health care more expensive.

Let's begin with the morbidly obvious. The longer people hang around the longer they utilize the health care system. End-of-life care is often the most expensive. Old folks just love doctors. (I know I plan to unleash septuagenarian fury on physicians regularly.) As studies on Medicare have proved, easy availability to services at the tail end of life translates into lots of needless services.

Second, a government policy that prods people into incessantly visiting medical offices for checkups, screenings, and tests will only raise costs even further. According to studies, preventive medicine thwarts little, though it does mean early diagnoses for relatively harmless ailments—and treatments for them.

As H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy, contends: "Recent expansions in the definitions of diabetes, high cholesterol and osteoporosis defined millions more as suddenly needing therapy. A new definition of 'abnormal bone density' ... turned 6.8 million American women into osteoporosis patients literally overnight."

There is another vital aspect of preventive health care that many health care professionals and bureaucrats simply refuse to accept: Some of us can't be helped.

A few years ago, I heard a highly educated and successful author maintain that a life without cigarettes and copious amounts of alcohol is a life not worth living. There exists no warning label, no bone-chilling study, no crafty public service announcement that is going to separate me from my sour cream- and cheese-infested burrito.

At this point, anyone who doesn't comprehend that french fries aren't a suitable vegetable substitute will not be aided by preventive health care—unless it includes the cost of a cerebral transplant.

There are also potential consequences to "prevention" policy.

For instance, you can "persuade" people to care by coercing them. Increasingly, elected officials are warming to the idea.

We've seen an explosion of intrusive legislation around the nation—sin taxes and ingredient bans, to name two. The more we collectivize health care policy the more your comrades will make it their business to demand preventive health calisthenics.

In a recent, amazingly uncritical article about preventive care in Time magazine, titled "This Doctor Does Not Want To See You"—because, as we all know, most doctors yearn for pervasive sickness—we read this pronouncement: "Ours is a system that rewards pills and procedures and nurtures a clinical culture in which the goal is primarily to fix what goes wrong."

You've got that right. Millions of Americans are now alive, living without excruciating pain, engaging in healthy sex lives, avoiding suicide, etc., because of pills and the clinical culture that many preventive care proponents like to denigrate.

It's one thing to blow off steam about corporate America, insurance companies, and overpriced drugs but quite another to undervalue technology. The idea that jumping jacks can take the place of pharmaceuticals is a dangerous one.

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  • NeonCat||

    C'mon, it's for former children.

    I must say, though, that the thought has occurred to me that through preventative care the people who are now creating vast future debts (and encouraging more debt through various publicly paid for health plans) will still be alive to reap what they have sown to be… satisfying, in a way. Not that they will accept the responsibility, but maybe Gen Z+1 will indict them for gross negligence and public malfeasance.

    A man can dream, can't he?

  • ||

    Moreover, Harsanyi continues, there is one vital aspect of preventive health care that many health care professionals and bureaucrats simply refuse to accept



    Unfortunately, as bad as health care professionals and bureaucrats are on this, the American people are even worse. Preventative care polls extremely well. Much better than the cutting unnecessary care that's the belief of health care reformers currently (and the source of the supposed, but politically impossible, savings under Obama, Orzsag, and Emanuel's plan.)

  • ||

    Why Preventive Care is a Sick Idea

    Um, Dave, you do know that the kids these days say something's "sick" when it's, like, cool and stuff.

  • ed||

    the kids these days say something's "sick" when it's, like, cool and stuff

    "Sick" has supplanted "stupid"? I missed that tweet. And get off my lawn.

  • ||

    Leave Dagny alone, she does the best she can.

    "The 80s didn't get to Canada until about 1992."

  • ||

    Leave Dagny alone, she does the best she can.

    Thanks, Sug. (sniffs) Too bad there's no preventive care to cure acute Canadianness.

  • ed||

    I'm serious. And clueless as to modern jive talk. And I just ate an undercooked porkchop.
    Will I get "sick"? And is it too late for preventative measures?

  • Xeones||

    Goddammit, Obama, i ain't forking over for inferior care for everybody just 'cause ed ate an undercooked porkchop.

  • ||

    As I like to say, "No doctor ever got a new Jaguar by saying, 'Get out of my office; there's nothing wrong with you!'"

    More "preventive care" visits will not not- I repeat, NOT- reduce health care costs.

  • ||

    ed, you're obvs hella sick.

    (hangs head in shame & resumes tweeting)

  • ||

    not

  • ||

    "The more we collectivize health care policy the more your comrades will make it their business to demand preventive health calisthenics."

    This really is the heart of the matter. When other people are paying for your healthcare, suddenly your choices are their business.

    So we can either stop asking other people to pay for our healthcare, or get used to them telling us how to live.

  • Ghetto Man||

    "Thanks, Sug. (sniffs) Too bad there's no preventive care to cure acute Canadianness."

    Ain't that what beer is for?

  • ed||

    Feeling queezy...

  • ||

    The gubmint has been paying for health care for decades via medicaid. We all know that these medicaid recipients are the healthiest folks in the whole world due to the lifestyle imposed upon them by the gubmint.

  • ||

    Like everything else nowadays, they've taken a sensible idea for individuals and collectivized it, turning it into a monster.

    I was brought up to see "preventive care" as taking care of yourself; not so much to extend life per se but to ensure that you're healthy enough to enjoy whatever years you get. It didn't involve being constantly poked and prodded by "experts", or having one's personal habits monitored by self-righteous busybodies.

    But just like "sick" the definition of "prevention" isn't what it used to be.

  • ||

    "The more we collectivize health care policy the more your comrades will make it their business to demand preventive health calisthenics."

    Obama needs to watch the Greta Garbo film "Ninotchka" twice a day, every day.

  • IceTrey||

    Actually if I was paying for other peoples health care I would encourage them to start smoking heavily or maybe start doing a huge amount of meth or heroin. Why? Because the sooner you die the less your total health care costs are. The real drains on the system are the people that live to be 85 or 90. If you're dead at 50 the rest of us get off cheaply.

  • ||

    Enjoy Every Sandwich,

    Love the name.

  • Fascitis Necrotizante||

    There was a WSJ article recently reporting that Medicare has declined to pay for non-invasive CAT scan colonoscopies because they were new, expensive and would have to be followed by an invasive one if a problem was discovered. I assume this will limit the number of people who may be getting early detection colonoscopies of any kind. Be interesting to see what other preventive treatments will be determined insufficiently cost effective by the national board that will be making these decisions for Obamacare enrollees.

    Also, what the government's fantastic price-lowering bulk-buying powers, the fact that Medicare would not reimburse for this treatment killed it for everyone.

  • Phlegm||

    Got any picture of that chick eating a weiner?

  • Invisible Finger||

    Some of us can't be helped.

    It's not about helping anyone. It's about taking their money.

  • Rich||

    Much "preventive care" would happen if elementary school kids had reasonable health classes and paid attention. But ... there I go again.

  • ||

    Goddammit, Obama, i ain't forking over for inferior care for everybody just 'cause ed ate an undercooked porkchop.

    PORKCHOP SANDWICHES

    Ain't that what beer is for?

    I thought that caused acute Canadian-ness. Well, at least Molson and Labatt's. And mac and cheese.

  • ||

    More Padma Lakshmi pics would cure many ills.

  • d||

    Harasanyi, you're dead wrong on this one. "Fixing" the problems of burrito-eating fat fucks who can't tell you what color shoes they're wearing is a Sisyphean battle that you'll never win.

    That's not to say that you should legislate so-called "preventative care". A regular trip to the MD is a sure-fire way to die of iatrogenic causes, not to prevent disease. People should be enabled (through laxer -- or no -- regulation of supplements and medical policies) to take control of their own health and prevent the need to see the old snake oil pusher (the MD) altogether.

    Re this unsubstantiated pronouncement: The idea that jumping jacks can take the place of pharmaceuticals is a dangerous one.

    Calling ideas 'dangerous' is far more dangerous than any idea.

  • Two Foot Stools||

    I love living healthy. It just makes good sense.

  • kilroy||

    Kroneborge, right on.

    Why is it the law says I have to wear a seatbelt again?

  • d||

    correction: not "medical policies", but "medical procedures".

  • ||

    Enough About Palin, likewise!

    I didn't originate the name, I stole it from the late Warren Zevon. I've no idea if he's the originator or not. In any case I like it.

  • ||

    I'm seriously thinking of changing mine to:

    Enough About McCain, Matt Welch.

  • ||

    "Second, a government policy that prods people into incessantly visiting medical offices for checkups, screenings, and tests will only raise costs even further." may be morbidly obvious, but not all obvious things are true.

    This article would be a lot more persuasive if it gave due credit to, say, dental care. Regular cleanings and screenings result in huge savings, as small cavities are much cheaper to fix than big ones, and cavities don't hurt until they're huge. That's just first order effects.

    Chronic inflammation from a septic mouth has all kinds of deleterious effects on health, making those hygiene visits even more important.

    Detecting high bloodpressure is another biggie. It's a lot cheaper to treat than heart disease or a stroke.

  • ||

    BTW, loved "Excitable Boy"

    He took little Suzie to the Junior Prom
    Excitable boy, they all said
    And he raped her and killed her, then he took her home
    Excitable boy, they all said
    Well, he's just an excitable boy
    After ten long years they let him out of the home
    Excitable boy, they all said
    And he dug up her grave and built a cage with her bones
    Excitable boy, they all said
    Well, he's just an excitable boy

  • ||

    "Detecting high bloodpressure is another biggie. It's a lot cheaper to treat than heart disease or a stroke.


    I can do that at Wal Mart.

    Don't need no Obama.

  • Granite26||

    My perception is that while total costs would rise, preventative care would reduce the avg cost of health care per year of a person's life.

    On a 'pay per year' plan, this would be a net positive.

    I could be wrong, though.

  • ||

    "A few years ago, I heard a highly educated and successful author maintain that a life without cigarettes and copious amounts of alcohol is a life not worth living."

    If you're going to use Christopher Hitchens, at least quote him.

  • Mike Laursen||

    Got any picture of that chick eating a weiner?

    Dude, you'll be happy to learn that there's a whole TV series that features "that chick" eating stuff.

  • ||

    My perception is that while total costs would rise, preventative care would reduce the avg cost of health care per year of a person's life.

    Doesn't work that way. Preventive care, currently practiced, consists of

    (a) tests on asymptomatic patients that nearly always find nothing and

    (b) chats with a provider about lifestyle changes that you already knew about and would be doing if you wanted to, but won't do just because you had a chat with provider about it.

    For the most part, its useless or pointless, but it ain't free. The savings from early detection of disease are mostly imaginary, but the costs are not.

  • ||

    This article would be a lot more persuasive if it gave due credit to, say, dental care. Regular cleanings and screenings result in huge savings, as small cavities are much cheaper to fix than big ones, and cavities don't hurt until they're huge. That's just first order effects.



    Except that regular dental care isn't that expensive. Depending on the level of cleaning and whether or not there's X-rays, it's about $50-$150 for a regular six month checkup. People spend that much on oil changes. I've known far more people who didn't get regular dental cleanings out of a mistaken idea that dental cleanings are too expensive without insurance than people who actually couldn't afford them. And a lot of what they do in a dental checkup is warn you about stuff that you should be doing anyway but aren't. The kind of people who don't get the checkups without being hectored into it are correlated with the kind of people who won't follow the advice.

    More preventative care is a great hope of not just politicians, but the public as well. Experts don't really believe that there's that much savings involved in preventative care and screenings-- arguably we're past the cost-effective point for some screenings. By contrast, they argue that there's too much use of excessive care.

    Obama's proposed savings come from eliminating excessive care, noting how some areas seem to spend 30% for the same outcome when they have similar demographics. But those sorts of restrictions are politically unpopular, so they won't happen.

  • Paul||

    the kids these days say something's "sick" when it's, like, cool and stuff

    If I had a cane, I'd shake it.

  • ||

    RC:
    Good points. Sounds like they are not getting enough of these preventive checkups with the current system. Why not force it us. Political motivation always seems so clear but the way they try to sell it continues to amuse me. They can't even figure out (or don't care) how tax payers are getting ripped off with medicaid overbilling schemes but this new system will be the answer?

    hint: Government will only pay so much because they assume they are getting overbilled. This encourages health care providers to overbill because they will get short changed. Atleast private insurance is forced to maintain some form of accountability to all the parties involved.

  • LarryA||

    "Second, a government policy that prods people into incessantly visiting medical offices for checkups, screenings, and tests will only raise costs even further." may be morbidly obvious, but not all obvious things are true.

    Detecting high blood pressure is another biggie. It's a lot cheaper to treat than heart disease or a stroke.


    You've missed the point. Healthy people live longer. Is treating someone for a stroke more expensive than treating someone for high blood pressure for sixty years? And then, eventually, the healthiest get old and there's ten years or so of long term care to pay for.

  • ||

    Preventive care works for those who want to be helped. Those who have untreatable disease or genetic defects can be helped in most cases even if they cannot be cured.
    There is another group who are dependent on community care as a social or cultural disease. The cost of these people far exceeds that of all other classes of patients combined and results not only in lifetime care but generational care, behavioral care, institutional care, and penal care.
    The cost depends on how the causes of health problems are treated. If health is thought of as a commodity and not the responsibility of the state to its citizens the conclusions are obvious. But the creation of a society that cares for its citizens will produce a more productive, less stressful environment at lowered cost.

  • ||

    Part of the problem with "preventive medicine" is genetics. People with good genes don't need it (witness people who smoke and live to 100), and people with bad genes are going to get sick no matter what you do. Similar reasoning goes for breast cancer. "Free" breast cancer screening is extremely popular among women (why wouldn't forcing men to subsidize women's health care be popular with women?), but mortality hasn't budged an inch after all the money we now spend on screening. The reason? Genetics. A woman with a slow growing cancer probably first contracted it in her 30s, and it's now visible in her 60s/70s. A mild treatment regimen to get rid of most of it, and she'll be long dead from the general ravages of old age before it comes back. On the other hand, a woman with an aggressive cancer is dead in 1.5-2 years no matter what treatment regimen she tries. The ads I hear on the radio claiming "early screening saved me" are essentially lies: what really matters is the type and aggressiveness of the cancer, not when you found it.

  • MJ||

    "Preventive care works for those who want to be helped."

    Whether preventative care "works" to improve an individual's health is irrelevant as to whether it works as means of systemic cost savings. Everyone is going to die of something, and treating those somethings before one succumbs them is going to remain expensive. The most likely result is that preventative care will raise systemic costs or do nothing as the preventative stuff does cost and if effective make chronic geriatric diseases more common.

    If your goal is longer lifespans, preventative care may be a likely success. If your goal is long term cost savings...probably a massive failure.

  • Tristan||

    Yeah, preventive care is B.S. Avoid fatty foods and smoking is the only cost effective preventive care.

    Check out this video on health care: http://www.youtube.com/watch?v=IQh--oWAR4Q

  • Marian Kechlibar||

    LarryA: I have high blood pressure and I find your comparison of relative costs of treating it vs. treating stroke almost absurd.

    Treatment of high blood pressure usually means taking some medication once or twice daily, and measuring your pressure from time to time. Even if it takes 60 years, it does not limit your productivity and does not make you dependent on someone's care. You basically live a life of a healthy person, with a few limitations. Which means that your treatment should be fully covered from your own personal income.

    On the other hand, a person who has suffered a stroke will probably be crippled for the rest of their lives. Most such people will be unable to work for a long time, if ever. They will be dependent on someone and are unlikely to be able to pay for their treatment. Someone else will do that.

    Can you see the difference?

  • Marian Kechlibar||

    A question to the broad forum: do you consider vaccination a form of preventive medicine? Me, yes.

    Generations that are alive now haven't experienced the horrors of smallpox or polio, so they tend to underestimate the impact of eradication (or almost-eradication, in case of polio) of those illnesses on the quality of life.

    Same with the black plague etc. (Go read Daniel Defoe's "A Journal of the Plague Year" - it is in public domain and can be downloaded for free. Horrible reading.).

    In my view, vaccination against deadly diseases is philosphically similar to defense against external aggression - can't really be limited to a subset of people.

  • Chad||

    Tristan | June 25, 2009, 1:30am | #
    Yeah, preventive care is B.S. Avoid fatty foods and smoking is the only cost effective preventive care.


    So is exercise, and in this country, the government does everything it can to ensure that we never have to get off our fat butts.

  • Marian Kechlibar||

    Chad, as a long-term sports practicioner, I can assure you that sport is a huge source of injuries. Most of my medical appointments is related to sports injuries.

    This is really a tradeoff between different sorts of medical problems. People like me usually have good cardiovascular health (with possible exceptions of high blood pressure, which seems to be genetic), but end up with arthritis in important joints.

    Obesity is not a specifically American problem. It is a problem which has, in the last 20 years, literally exploded over the whole world, even in Africa you have 20 to 30 per cent of overweight people. And the trends in some countries like Mexico are even more alarming.

    In my opinion, this has a lot to do with urbanization, and something with genetics as well.

    Did you know that Lithuanian people are exceptionally slim, especially with regard to their national diet which is based on cream and similar caloric bombs? There are some serious genetic studies running, trying to explain this fact.

  • Phillip Conti||

    I think that David Harsanyi hinted at a major problem in american health care, a lot of the spending goes at the end of life. People's bodies break down at some point irrespective of how much Obama cares. However, this is a political problem (AARP and such) not a health problem. We could all eat better, get the latest vaccines, stop smoking, reduce our alcohol consumption - none of which would invalidate public choice economics.

  • Marian Kechlibar||

    Heh, about 40% of the Czech national healthcare expenses are spent on patients in their last 6 months of life.

    That is a feature of the problem. Often, you cannot determine whether a given therapy will save a life or not. In older people, it is more probable that it won't.

  • ||

    For people who would like data, and not just assertions, here's an article in the New England Journal of Medicine discussing that prevention is not apparently cost-saving over treatment. More discussion here.

    Politicians and the public love the idea of saving money via prevention. But the data doesn't support it.

  • LarryA||

    Treatment of high blood pressure usually means taking some medication once or twice daily, and measuring your pressure from time to time. Even if it takes 60 years, it does not limit your productivity and does not make you dependent on someone's care. You basically live a life of a healthy person, with a few limitations. Which means that your treatment should be fully covered from your own personal income.

    On the other hand, a person who has suffered a stroke will probably be crippled for the rest of their lives. Most such people will be unable to work for a long time, if ever. They will be dependent on someone and are unlikely to be able to pay for their treatment. Someone else will do that.

    Can you see the difference?


    Absolutely. And I agree that preventive care should be part of health care and that it can increase quality of life, and so forth.

    But it will not lower long-term medical expenses. It isn't the person who has a stroke, requires care for five years, then dies at age 60 who costs the health care system the most. It's the person who lives to be 105, requires health care for 45 more years, and spends the last 10-15 years in long term care who runs up the big tab.

    Again, I'm firmly on the side of keeping people healthy even if it does cost more dollars. But not if it costs more freedom.

  • abercrombie milano||

    My only point is that if you take the Bible straight, as I'm sure many of Reasons readers do, you will see a lot of the Old Testament stuff as absolutely insane. Even some cursory knowledge of Hebrew and doing some mathematics and logic will tell you that you really won't get the full deal by just doing regular skill english reading for those books. In other words, there's more to the books of the Bible than most will ever grasp. I'm not concerned that Mr. Crumb will go to hell or anything crazy like that! It's just that he, like many types of religionists, seems to take it literally, take it straight...the Bible's books were not written by straight laced divinity students in 3 piece suits who white wash religious beliefs as if God made them with clothes on...the Bible's books were written by people with very different mindsets

  • Scarpe Nike Italia||

    is good

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